Provider Demographics
NPI:1023030723
Name:WHEATON FRANCISCAN HEALTHCARE-TERRACE AT ST. FRANCIS, INC
Entity Type:Organization
Organization Name:WHEATON FRANCISCAN HEALTHCARE-TERRACE AT ST. FRANCIS, INC
Other - Org Name:WHEATON FRANCISCAN HEALTHCARE-TERRACE AT ST. FRANCIS, INC DMERC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIVIANE
Authorized Official - Middle Name:G
Authorized Official - Last Name:DORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-389-3251
Mailing Address - Street 1:3200 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4442
Mailing Address - Country:US
Mailing Address - Phone:414-389-3200
Mailing Address - Fax:414-389-3300
Practice Address - Street 1:3200 S 20TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4442
Practice Address - Country:US
Practice Address - Phone:414-389-3200
Practice Address - Fax:414-389-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3147314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1067240001Medicare NSC